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Finally, after nearly a decade of little or no change in the families of one-step or two-step peroxide disinfecting systems, comes a major breakthrough in the cleaning of silicone hydrogel contact lenses. PeroxiClear (Bausch + Lomb), a 3% hydrogen peroxide cleaning and disinfecting system that became available earlier this year, will no doubt be adopted with enthusiasm.
The market share for peroxide-based soft contact lens cleaning systems is about 12% of the total US market, according to Bausch + Lomb. The small market share to date for peroxide systems can be attributed to the fact that many practitioners resort to peroxide systems only for problem cases. That is, doctors frequently suggest a peroxide regimen because comfort levels or deposit issues have contributed to patients’ unhappiness with their current care regimen. Patients who have excessive deposits on the contact lens surface or who complain of dryness with lens wear seem to be prime candidates for peroxide systems.
A recent study conducted by Bausch + Lomb demonstrated that, of patients using current hydrogen peroxide systems, 52% had complaints of dry eye discomfort, and 44% had lens buildup issues. These data suggest that there is a need for a better peroxide system than what has previously been available.
The one-step hydrogen peroxide system is the most frequently used in the family of the peroxide disinfecting agents. Consumers who were asked about their peroxide cleaning agents stated that the peroxide kit did in fact improve their issues to some extent, but by no means solved their problems of dryness and lens deposits that had contributed to their lens discomfort.1 The amount of buildup on silicone hydrogel lenses (lipids and protein from the tear film) is well documented,2 and many patients using peroxide cleaning systems have reported protein buildup while wearing the lenses.3
PeroxiClear is a one-step peroxide cleaner and disinfecting system that aims to offer the patient more comfort and protection from dryness by increasing the hydration of the lens and reducing deposits on the contact lens surface. The issues of dryness and deposits are resolved by the system’s three ingredients—a surfactant, a demulcent, and a humectant—which may allow higher moisture retention when a contact lens is inserted for the whole day.
Surfactants are compounds that reduce the energy required to wet a surface; in this case, the surfactant is poloxamer 181, a unique polymer that attracts and retains moisture and thus improves the wetting of the lens. A demulcent is a substance that relieves the irritation of mucous membranes by forming a protective film. The demulcent used in this product to protect and lubricate the ocular surface and relieve dryness and irritation is propylene glycol, a water-binding moisturizer that can hold nearly three times its weight in water. A humectant is a substance used to retain moisture. In this formulation, carbamide is the moisturizing molecule that forms a hydrogen bond with water and is used to improve the compound’s hydrating properties.
The retention of the surfactant poloxamer 181 on a lens worn by a patient suggests that moisture retention lasts up to 20 hours with PeroxiClear, as compared to moisture retention for up to 1 hour of wear with the older peroxide system. In another comparison, after 30 days of wear, a lens cleaned with PeroxiClear had a 72% deposit-free surface, whereas a lens cleaned with the old peroxide system had a 49% deposit-free surface. Another striking difference is that cleaning lenses with the PeroxiClear system takes 4 hours, while the older system required at least 6 hours.
Today, eye care physicians can confidently resolve their lens-wearing patients’ problems with dry eyes and deposits by recommending a system that is geared to manage these issues.
Mel A. Friedman, OD, is in private practice at For Your Eyes Only in Memphis. He is a consultant to Allergan and Bausch + Lomb. Dr. Friedman may be reached at firstname.lastname@example.org.
- Ngo W, Heynen M, Joyce E, Jones L. Impact of protein and lipid on neutralization times of hydrogen peroxide care regimens. Eye Contact Lens. 2009;35(6):282-286.
- Baines M, Cai F, Backman H. Absorption and removal of protein bound to hydrogel contact lenses. Optom Vis Sci. 1990;67(11):807-810.
- Millward Brown Healthcare. A multi-country market research study conducted online amongst 202 eye care professionals, all responsible for recommending hydrogen peroxide solutions in their practice. May/June 2011.
- Nichols WF, Hoteling AJ. Mass spectrometry. Poster presented at: 61st American Society for Mass Spectrometry Conference on Mass Spectrometry; June 9-13, 2013; Minneapolis, MN.